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Maryland rates for HCPCS 72157

Mri Spinal Canal Thoracic W/O & W/Contr Matrl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$126.00 / $128.06 / $250.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.39 / $475.00 / $1,839.39
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$115.21 / $158.09 / $567.02
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$273.27 / $335.00 / $876.26
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$483.83 / $526.50 / $997.10
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$121.15 / $129.12 / $162.32
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$362.68 / $402.97 / $874.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.51 / $619.73 / $1,244.55
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$84.81 / $137.63 / $259.44
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$198.47 / $428.61 / $1,103.11
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.23 / $435.03 / $784.17
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$108.30 / $134.25 / $216.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$227.22 / $293.11 / $599.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.11 / $522.54 / $1,064.64
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.30 / $119.81 / $198.25
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$225.21 / $363.16 / $828.66
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.77 / $366.19 / $476.05
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$88.00 / $115.21 / $149.77
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$181.78 / $250.98 / $320.85